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Fax membership application form
Bath Royal Literary and Scientific Institution (Charity reg. No. 304477) Company reg. No. 2857000

Application for membership of the BRLSI is open to all on receipt of payment of an annual subscription. The rates are as follows
(please tick one only).		 To apply for membership of the BRLSI, please complete this form and FAX it to:
(UK dialing:) 01225 442460
(International dialing:) 0044 1225 442460
Individual Membership 25.00
Couple Membership 40.00
Concessionary Membership (Students) 8.00
Family Membership 45.00
(2 Adults & 2 Children)
Benefactor 70.00

all amounts in Pounds Sterling

As a member you become entitled to access to the newly renovated Queen Square premises and displays of collections during opening hours; attendance at BRLSI meetings, lectures, exhibitions; the election of the Trustee body; and receive a periodical newsletter and email updates.
Facilities which are planned for the future are: permanent museum displays, temporary exhibition gallery, meeting rooms, schools activity room, reading room, virtual museum and library.

your details: (*must be cardholder)
*Name:(Mr./Mrs./Miss./Ms).............................
.....................................................................
Address:........................................................
.....................................................................
.....................................................................
...................................Post/ZIPcode:................
Telephone:.....................................................
Email.............................................................
like to receive our weekly email? Y/N......

.....Mastercard:Visa:Switch
Debit/Credit card details

Card Number: ........... ............ ............ ...........
Card Expiry Date:................................(eg 12/04)
Card Valid from Date:...........................(eg 11/01)
Card Issue Number:............................ (usually 1)
Amount to be deducted from card £...................
Gift Aid (UK only) To the Trustees of the Bath Royal Literary and Scientific Institution
Because the Institution is a Registered
Charity (no. 304477) and a registered
company (no. 2857000) you can, if you pay
income tax, enhance your contribution
at no extra cost to yourself by also
completing this section

For us to claim tax you must be paying income tax (or capital gains tax) at least equal to the amount we reclaim on you donation. Please notify us in confidence of any change ( if you do not pay income tax we cannot claim ).
I,......................................................................
(full name in block letters)
of the above address, wish all donations I make to the BRLSI to be treated as Gift Aid payments, until I notify you otherwise. I confirm that I will be paying UK income or capital gains tax in excess of the tax reclaimed by the Institution on my donations

I wish to pay the BRLSI the sum of: £.........................
(the amount should be the cost of your annual subscription)

Signed: .......................................... Date: ........................